Depressive symptomatology after mild-to-moderate traumatic brain injury: a comparison of three measures

Representation in rehabilitation research of adults with traumatic brain injury and depression: A scoping review

Objective: To determine how well comorbid depression is described, defined, and measured in the rehabilitation literature that pertains to TBI and depression.Method: Scoping review of the rehabilitation sciences literature. Six databases were searched (to October 17, 2018) using the three core concepts of TBI, depression, and rehabilitation, as was for gray literature. Two independent reviewers reviewed documents for eligibility.Results: 3737 records were reviewed and 137 documents were analyzed. Primary studies (n = 126) were most prevalent and of quantitative descriptive design (n = 102). The number of participants with TBI and comorbid depression could only be determined for 81/126 (64%) of primary studies, in which they are the minority (median of 30% of sample). Depression reporting was heterogeneous and individuals with TBI and depression were not analyzed as a subgroup in most studies (n = 68, 55%). Depression self-report instruments are commonly used (14 instruments used in 111 studies). Few studies (n = 14, 19%) have participant samples with discrete severity levels of TBI and depression.Conclusions: Better participant representation and reporting of TBI and depression variables are needed to enhance comparability across studies and improve rehabilitation outcomes.

A randomised control trial of walking to ameliorate brain injury fatigue: a NIDRR TBI model system centre-based study

Fatigue is one of the most commonly reported sequelae after traumatic brain injury (TBI). This study evaluated the impact of a graduated physical activity programme on fatigue after TBI. Using a prospective randomised single-blind crossover design, 123 individuals with TBI, over the age of 18, were enrolled. Interventions included a home-based walking programme utilising a pedometer to track daily number of steps at increasing increments accompanied by tapered coaching calls over a 12-week period. Nutritional counselling with the same schedule of coaching calls served as the control condition. Main outcome measures included: the Global Fatigue Index (GFI), the Barrow Neurological Institute (BNI) Fatigue Scale Overall Severity Index Score, and the Multidimensional Fatigue Inventory (MFI). Step counts improved over time regardless of group assignment. The walking intervention led to a decrease in GFI, BNI Total, and MFI General scores. Participants reported less fatigue at the end of the active part of the intervention (24 weeks) and after a wash out period (36 weeks) as measured by the BNI Overall. The study suggests that walking can be used as an efficient and cost-effective tool to improve fatigue in persons who have sustained a TBI.

Saccadic eye movements in mild traumatic brain injury: a pilot study

OBJECTIVE

To investigate whether repeat saccadic reaction time (SRT) measurements using a portable saccadometer is useful to monitor patients with mild traumatic brain injury (mTBI).

METHODS

Seven patients with newly-diagnosed mTBI and five agematched controls were prospectively recruited from an emergency Department. Saccadic eye movements, symptom self-reporting and neuropsychological tests were performed within one week of injury and again at follow-up three weeks post-injury. Control patients underwent saccade recordings at similar intervals.

RESULTS

Median saccade reaction times were significantly prolonged within one week post-injury in mTBI compared to controls. At follow-up assessment there was no significant between-groups difference. Changes in median SRT between the two assessments were not statistically significant. Four of the seven mTBI patients showed significantly increased SRT at follow-up; three of the mTBI patients and all controls showed no significant change. Among the three mTBI patients with persistent decreased SRT, two experienced loss of consciousness and reported the greatest symptoms, while the third was the only subject with significant decrease in neuropsychological testing scores at both assessments.

CONCLUSION

In three of seven mTBI patients, saccadic eye movements remained delayed within three weeks post-injury. These three patients also showed persistent symptoms or no improvement on neuropsychological testing. This pilot study using a portable saccadometer suggests that comparing SRT from three weeks post-injury to that within one week of injury may be useful for early detection of a subpopulation at risk of persistent disability from mTBI. This finding suggests that further investigation in a large study population is warranted.

Les saccades oculaires dans le traumatisme cérébral léger : une étude pilote.

Stochastic Curtailment of Questionnaires for Three-Level Classification: Shortening the CES-D for Assessing Low, Moderate, and High Risk of Depression

In clinical assessment, efficient screeners are needed to ensure low respondent burden. In this article, Stochastic Curtailment (SC), a method for efficient computerized testing for classification into two classes for observable outcomes, was extended to three classes. In a post hoc simulation study using the item scores on the Center for Epidemiologic Studies-Depression Scale (CES-D) of a large sample, three versions of SC, SC via Empirical Proportions (SC-EP), SC via Simple Ordinal Regression (SC-SOR), and SC via Multiple Ordinal Regression (SC-MOR) were compared at both respondent burden and classification accuracy. All methods were applied under the regular item order of the CES-D and under an ordering that was optimal in terms of the predictive power of the items. Under the regular item ordering, the three methods were equally accurate, but SC-SOR and SC-MOR needed less items. Under the optimal ordering, additional gains in efficiency were found, but SC-MOR suffered from capitalization on chance substantially. It was concluded that SC-SOR is an efficient and accurate method for clinical screening. Strengths and weaknesses of the methods are discussed.

An evaluation of an online peer support forum for university students with depressive symptoms

BACKGROUND

Depression is the most common mental health problem among young people, particularly university students, with prevalence rates as high as 48% reported. This population however, is reluctant to seek professional help. Online interventions may be particularly appealing to students, with evidence suggesting that they use the Internet for mental health support. While there are many mental health resources on the Internet few focus specifically on the needs of young people and few have been evaluated. This research aimed to develop and pilot test an online peer support intervention for students experiencing depressive symptoms.

METHODS

A depression support Web site (www.losetheblues.ie) was designed specifically for 18-24 year old students. The study used a mixed method, involving quantitative descriptive, pre- and post-test and qualitative descriptive designs. Data were collected using the Centre for Epidemiological Studies Depression Scale (CES-D), a background questionnaire and online forum posts.

RESULTS

The sample consisted of 117 university students with self-reported depressive symptoms. Results from participants in the pre- and post-test element of the study, showed no statistical significance. The forum posts revealed that the participants' main difficulties were loneliness and perceived lack of socialization skills. The Web site provided a place for sharing, offering and receiving emotional and informational support.

CONCLUSION

Developing health care interventions in an online environment presents unique challenges to the research process, however they have the potential to provide mental health care that is accessible and affordable.

Interpersonal relatedness and psychological functioning following traumatic brain injury: implications for marital and family therapists

Recovery from a mild-to-moderate traumatic brain injury (TBI) is a challenging process for injured persons and their families. Guided by attachment theory, we investigated whether relationship conflict, social support, or sense of belonging were associated with psychological functioning. Community-dwelling persons with TBI (N = 75) and their relatives/significant others (N = 74) were surveyed on relationship variables, functional status, and TBI symptom severity. Results from this cross-sectional study revealed that only sense of belonging was a significant predictor of postinjury psychological functioning, although interpersonal conflict approached significance. No relevant preinjury or injury-related variables impacted these relationships, except marital status. Our findings suggest that interventions targeting strengthening the injured persons' sense of belonging and lowering interpersonal conflict may benefit those living with TBI.

Sex and age differences in depression and baseline sport-related concussion neurocognitive performance and symptoms

OBJECTIVE

To examine depression and baseline neurocognitive function and concussion symptoms in male and female high school and college athletes.

DESIGN

Cross sectional.

SETTING

Athletes completed testing at a designated computer laboratory at high schools and colleges.

PARTICIPANTS

Participants included 1616 collegiate (n = 837) and high school (n = 779) athletes from 3 states participating in a variety of competitive sports.

INTERVENTIONS

Participants completed the baseline Immediate Postconcussion Assessment and Cognitive Test (ImPACT), symptom inventory, and Beck Depression Inventory II (BDI-II).

MAIN OUTCOME MEASURES

Between-group comparisons for depression groups on ImPACT composite scores (verbal and visual memory, reaction time, motor processing speed), total symptoms, and symptom cluster (sleep, cognitive, emotional, somatic/migraine) scores. Between-group comparisons for age and sex on BDI-II, ImPACT, total symptoms, and symptom cluster scores.

RESULTS

The severe depression group scored worse on visual memory and reported more total, somatic/migraine, cognitive, emotional, and sleep symptoms than less depressed groups. High school athletes reported more somatic/migraine symptoms than collegiate athletes, whereas collegiate athletes reported more emotional and sleep symptoms than high school athletes. Women had higher verbal memory and reported more cognitive, emotional, and sleep symptom clusters compared with men. Women outperformed men on verbal memory, whereas collegiate athletes outperformed high school athletes on processing speed.

CONCLUSIONS

Athletes with severe depression scored lower on visual memory than those with minimal depression. Athletes with severe depression report more concussion symptoms than athletes with minimal and moderate depression scores. Symptoms of depression should be included in baseline assessments to help disentangle depression from concussion symptoms.

Looking beyond the importance of life goals. The personal goal model of subjective well-being in neuropsychological rehabilitation

Objective: To identify subjective importance, attainability and success of life goals and their predictive value for subjective well-being in patients with acquired brain injury.

Design: Cross-sectional, descriptive.

Setting: Two inpatient neurological rehabilitation centres.

Participants: Patients with non-progressive neurological disorders. Interventions: Survey using questionnaires.

Measures: Life goal characteristics were assessed using a life goal questionnaire (GOALS). Subjective well-being (composite score) was measured using the Center of the Epidemic Studies Depression Scale (CES-D), the Positive and Negative Affect Schedule (PANAS) and the Satisfaction With Life Scale (SWLS).

Results: Fifty-nine patients participated in the study. The most important life goals are intimacy (4.59/5), achievement (3.96/5) and altruism (3.89/5). The intimacy goals are considered most attainable (4.19/5) and patients feel most successful in this domain (3.98/5). Two important predictions of the personal goal model of subjective well-being could be confirmed. First, goal attainability moderates the relation between goal importance and goal success. Second, the influence of goal importance on subjective well-being is mediated by experienced success. The most powerful predictors for subjective well-being are success in the achievement domain (β = 0.404) and discrepancy between importance and success in the intimacy domain (β = —0.276).

Conclusions: The subjective well-being of neurological patients depends not only on the appraised importance of life goals but also on their attainability and success.

Selbstkonzept nach erworbenen Hirnschädigungen: Veränderungen der Selbstwahrnehmung und Subjektives Wohlbefinden

Negative Selbstkonzepte stehen in Zusammenhang zu erhöhter depressiver Symptomatik, vermehrter psychosozialer Belastung und reduzierter Lebensqualität, was ihre Relevanz für Rehabilitationsprozesse begründet. Untersucht wurden Selbstkonzeptveränderungen nach erworbenen Hirnschädigungen bei PatientInnen der akuten (N = 59) und postakuten (N = 29) Rehabilitationsphase. Beide Stichproben bewerten aktuelle Selbstkonzepte verglichen mit prämorbiden Einschätzungen negativ. Faktorenanalytisch wurden 2 Selbstkonzeptbereiche ermittelt („Emotionales Erleben“, „Eigenschaften in sozialen Interaktionen“), die von der Erkrankung unterschiedlich stark betroffen sind. Negative aktuelle Selbstkonzepte stehen in engem Zusammenhang zu reduziertem Subjektivem Wohlbefinden und erklären regressionsanalytisch einen substantiellen Varianzanteil des Subjektiven Wohlbefindens. Soziodemographische und schädigungsbezogene Variablen spielen demgegenüber eine untergeordnete Rolle. Die Ergebnisse sprechen für die Berücksichtigung von Interventionen zur positiven Beeinflussung des Selbstkonzeptes in der psychotherapeutischen Behandlung von PatientInnen mit erworbenen Hirnschädigungen.

Functional Status, Chronic Stress, and Cortisol Response After Mild-to-Moderate Traumatic Brain Injury

It is well known that individuals experience difficulties with depressive symptoms and functional status after traumatic brain injury. However, it is unclear what the relationship is between these 2 phenomena and whether there is a biological explanation for. In this secondary analysis, we examined whether depressive symptoms explained postinjury functional status and whether chronic stress and salivary cortisol influenced this relationship. Participants included 75 persons within 24 months of their injury dates who were evaluated or treated in specialty clinics. All participants and a family member or significant other completed survey data, and 50 of the participants provided cortisol data. Results indicated that chronic stress, measured using Cohen's Perceived Stress Scale, completely mediated the relationship between depressive symptoms, measured using the Center for Epidemiological Studies Depression Scale, and psychological functioning, measured using the Patient Competency Rating Scale. Furthermore, those who provided cortisol data displayed hypocortisolemia in their 12-hr profile. Results from this analysis suggest that interventions focused on addressing the chronic stress experience may be important in limiting depressive symptoms and improving psychological functioning. Longitudinal study of this phenomenon is required to understand the progression of chronic stress after traumatic brain injury.